Nurse - and lawyers - challenged about fluid death statements to the coroner

The public inquiry into Hyponatraemia-related Deaths was announced in 2004

By Ruth O’Reilly

A RETIRED nurse was today challenged about evidence she gave to the Coroner’s Court about the death of a child in her care, and told it appeared she had not spoken “so openly and frankly” there as she had at an internal hospital review.

Elizabeth Millar, who was the ward sister in Altnagelvin Hospital at the time Raychel Ferguson was administered a lethal dose of intravenous fluid, was scrutinised about her view of how unwell Raychel had appeared before she collapsed in June 2001 and what she had shared with the Coroner who investigated the death in 2003.

Mr Justice O’Hara, who is chairing an inquiry into the death of nine year-old Raychel and other children through fluid mismanagement in hospitals here, also raised questions about a statement issued to the Coroner by lawyers for the Health and Social Care Board’s Directorate of Legal Services (DLS) – which said the Trust “strongly disputed” a conclusion that Raychel had suffered “severe and prolonged” vomiting before her collapse.

The letter from the DLS stated that the nurses who had cared from Raychel had “been interviewed in detail about this matter”. But at today’s hearing Mrs Millar said she had no recollection of any such interview.

For more background information on the issues being examined by the Hyponatraemia Inquiry please click here.

Raychel collapsed and never recovered more than 24 hours after having her appendix removed. Her parents maintain that she vomited repeatedly and often profusely throughout the day leading up to this – which would have made her system particularly prone to the electrolyte disturbance, in turn making the fluid even more dangerous.

Sister Millar confirmed that she was among a group of nurses who attended a review into Raychel’s treatment two days after her death, in which she has been quoted as stating that Raychel’s blood electrolytes should have been checked in the afternoon “because of the continued vomiting”.

However she said she could not recall making any comments about electrolytes at that meeting, nor could she explain why in her statement to the Coroner, which she wrote out herself three days after the review, she had made no reference to the view aired in at the review that Raychel’s electrolytes should have been checked.

She was also challenged about another claim made in her statement.

Mr Justice O’Hara: Could I take you to the last paragraph: ‘All members of nursing staff were devastated …’ And I’m sure that’s right, but would you look at the next sentence: ‘It was totally unexpected as she had been recovering very well on Friday the 8th.’ Now, if you told the critical incident review that she should have had her electrolytes taken on the afternoon because of her continued vomiting, that must be inconsistent with her recovering very well, mustn’t it?

Mrs Millar: Yes.

Mr Justice O’Hara: — because you can’t be recovering very well if you need your electrolytes taken because you’re vomiting so much?

Mrs Millar: Mm-hm. No, I would agree that that sentence is not right.

Mr Justice O’Hara: I’m afraid what I have to then ask you, Mrs Millar, is this: how does it come to be written? How does it come to be written that you say in your statement that she’s recovering very well when that simply wasn’t the case? I mean, if she’d been recovering very well on the Friday, by some point on Friday afternoon — as Friday went on, she would have been sipping more and more. The intravenous fluid would have been diminished and then stopped, and she would have started to eat; isn’t that right? That was the expected recovery path, and that is a child who does that is recovering very well.

Mrs Millar: Mm-hm.

Mr Justice O’Hara: A child who isn’t sipping beyond one or two sips, a child who isn’t eating, a child who’s still on IV fluid and a child who gets two anti-emetics is not a child who’s recovering very well.

Mrs Millar: Mm-hm. No, I would agree with you.

Counsel to the Inquiry, Mr John Stewart: Can I ask you, have you at all times, since 2001, been aware of the UKCC [United Kingdom Central Council for Nursing, Midwifery and Health] code of professional conduct?

Mrs Millar: Yes.

Mr Stewart: And aware of the guidance in relation to it given by the UKCC Guidelines for Professional Practice of 1996? And paragraph 24 of that is about truthfulness: ‘Patients and clients have a legal right to information about their condition. Registered practitioners providing care have a professional duty to provide such information. A patient or client who wants information is entitled to an honest answer.’ Do you think that Mr and Mrs Ferguson have had honest answers?

Mrs Millar: Um … (Pause). Well, I — I mean, it’s very difficult. I agree that — I mean, that sentence that I wrote, that it was totally unexpected, she had been recovering well, is wrong. But it’s not — I mean, why I wrote that, I — you know, I have no answer for that. It wasn’t trying to tell untruth. I don’t know why I wrote that.

Mr Justice O’Hara: Let’s move away for a moment about whether somebody’s lying. That statement does not tell the truth about what happened to Raychel; is that right?

Mrs Millar: Yes. But at the time, you know, it was — I mean, it wasn’t written in trying to, you know, tell an untruth. But I would have to agree that she was not recovering well.

Mr Justice O’Hara: Okay.

Later in the hearing Mr Michael Stitt QC, who is acting for the trust on the instructions of the DLS, said that the letter sent to the Coroner in 2003 by the DLS – stating that the nurses believed Raychel’s level of sickness was neither prolonged nor severe – was consistent with Mrs Millar’s view at the time “notwithstanding the answers which she’s given you”.

However Mr Justice O’Hara replied:

Mr Justice O’Hara: But I’m not clear where the information on that letter comes from if she wasn’t interviewed.

Mr Stitt: Well, she can’t remember being interviewed. I can’t comment any further. It’s not my place to do so, and you’ll form your own view, sir, but this is 2013.

Mr Justice O’Hara: Yes, but I’m sorry, I need a bit more than that, Mr Stitt. This was an issue which the trust was contesting. The basis for the contest is set out in this letter written by your instructing solicitor, I assume that the letter’s written on instructions from the trust, and in light of what we have heard about what was agreed at the critical incident review we’re trying to get to the root of the information contained in this letter. Now, if this witness wasn’t — effectively her two major contributions are her presence at the critical incident review and the statement she then wrote, which became her coroner’s statement. If that’s her contribution and she was not part of any subsequent interview on her own or with other nurses, at least so far as Sister Millar is concerned, where does this information come from? That’s what I’m trying to get at.

Mr Stitt: I understand where you’re trying to get to, and I for one certainly wouldn’t want to stand in your way, Mr Chairman, but I am saying that her answer is not inconsistent with the letter, but your point is a different one.

Later the chairman also challenged Mrs Millar about her failure to clearly set out in her statement complaints she had about the availability of doctors on the ward at the time and she said she was not thinking at the time of writing her statement about the difficulties her team had.

Mr Justice O’Hara: I’m sorry. In light of everything around Raychel’s case, including the specific difficulty on the Friday afternoon in getting a doctor, and in light of the discussions afterwards in the critical incident review, and in light of the changed practices that you told me about when I asked you before the break, how could you not have been thinking about that when you were giving evidence to the coroner about Raychel? Let me spell this out to you, Sister Millar. It rather looks as though you didn’t pull your punches in the hospital, in the critical incident review, but then you didn’t speak quite so openly and frankly when you were before the coroner. That’s how it looks to me. Now, if that’s not fair, please tell me why it’s not fair.

Mrs Millar: Well, I expect I should have expanded on that for the coroner, but I didn’t.